Provider Demographics
NPI:1851540470
Name:DARR, AMANDA LEE (OTR)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:DARR
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LEE
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:615 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-2615
Mailing Address - Country:US
Mailing Address - Phone:307-358-6187
Mailing Address - Fax:307-358-4891
Practice Address - Street 1:615 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:WY
Practice Address - Zip Code:82633-2615
Practice Address - Country:US
Practice Address - Phone:618-730-7358
Practice Address - Fax:307-358-4891
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY241683225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist